Live birth after rupture of a non‐communicating horn of a bicornuate uterus

Abstract

Case reportA 33-year-old woman presented with abdominal pain at 30 weeks of gestation. A previous pregnancy had resulted in a ventouse delivery of a live boy. Her second pregnancy had been complicated by first trimester vaginal bleeding. First and second trimester ultrasound confirmed a bicornuate uterus with a live fetus in the left-sided moiety. She booked with her community midwife for home delivery.At 30 weeks of gestation she presented with sudden onset of cramping abdominal pain several hours after a grape seed oil massage. She had no associated vaginal bleeding and fetal movements were normal. Examination showed an appropriate symphysio-fundal height, breech presentation and mild tenderness over the uterus. Her observations were normal and fetal cardiotocograph (CTG) was satisfactory. Three hours later her pain and uterine tenderness increased and a fetal bradycardia was followed by fetal tachycardia. She was taken to theatre for caesarean section under general anaesthetic with the likely diagnosis of concealed placental abruption.Intra-abdominal haemorrhage was found. A lower uterine segment incision was made but the fetus was not found within this cavity. A classical incision was then performed over the left side of the uterus and a female infant delivered with an Apgar score of three at 1 minute and eight at 5 minutes. She was intubated and resuscitated by the neonatologists and transferred to the neonatal intensive care unit.Following delivery the uterus was externalised for closer inspection. The uterus had ruptured at the left side of the fundus. There was a thick septum dividing the uterus into two halves with no connection between the left side and right side and no connection between the left side of the uterus and the cervix. Furthermore, there was evidence of placental implantation in the left side of the uterus (Fig. 1).The combined effect of a lower segment and classical incision, in addition to a ruptured fundus, resulted in an atonic uterus. Despite suturing, pressure, syntocinon and the prostaglandin analogue carboprost (Hemabate), haemostasis was not achieved so the decision was made to proceed to caesarean hysterectomy.Following a 10-unit blood transfusion and high dependency care she made a full recovery and was discharged on day 7. The baby required 24 hours of intubation and surfactant. She received antibiotics for three days and remained on the neonatal unit to establish feeding. She was discharged on day 40. At their postnatal appointment nine weeks later both mother and baby were doing well. DiscussionCongenital uterine anomalies occur in 0.5% of women. 1 The variant of the septate uterus where the uterus is completely divided by the septum and one of the hemicavities does not communicate with the cervix, vagina or contralateral hemicavity was described by Robert in 1969. 2 Six cases have been reported. 2,3 These have mainly presented with primary dysmenorrhoea, abdominal pain and unilateral blood or fluid collection.The above case is one of two reports of a pregnancy occurring in ...

Uterine rupture

“…In one case the clinicians achieved a live birth after rupture of a non-communicating horn of a bicornuate uterus at 30 weeks' gestation but a hysterectomy was required [29]. In another patient there was rupture of a non-communicating horn at 27 weeks' gestation with neonatal and maternal survival.…”

Rupture of bicornuate uterus

“…The walls of the anomalous uteri tend to become abnormally thin as pregnancies advances. Thickness can be inconsistent over different aspects of the myometrium, and the placenta does not adhere properly 7. The rupture in rudimentary horn is likely to occur in late first trimester or even in second trimester.…”

Successful post-term pregnancy in scared bicornuate uterus: case report

“…In a large review report including a combined population of infertile and fertile women, the frequency of anomalies by type was: septate (35%), bicornuate (26%), arcuate (18%), unicornuate (10%), didelphys (8%), and agenesis (3%) [ 9 ]. However, these proportions can vary substantially depending upon the specific population studied and the methodology used to identify the abnormalities [ 10 ].…”